| NPI | 1982699039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0041986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD20130017) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2017-02-16 |